Provider Demographics
NPI:1972860369
Name:LESAJEAN M. JENNINGS, PSY.D.
Entity Type:Organization
Organization Name:LESAJEAN M. JENNINGS, PSY.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESAJEAN
Authorized Official - Middle Name:MCDONALD
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:713-225-2280
Mailing Address - Street 1:1319 LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-4408
Mailing Address - Country:US
Mailing Address - Phone:713-225-2280
Mailing Address - Fax:713-225-5787
Practice Address - Street 1:1319 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-4408
Practice Address - Country:US
Practice Address - Phone:713-225-2280
Practice Address - Fax:713-225-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10020773OtherAMERIGROUP
TX107094OtherSUPERIOR
TX135153OtherVALUE OPTIONS
TX0062BTOtherBLUE CROSS / BLUE SHIELD
TX167799OtherCOMPSYCH
TXJENNI-0006OtherCOMPCARE
TX1136236-01Medicaid
TX167799OtherCOMPSYCH